Resist the tendency to label your patients

Several friends have pointed out to me their observations of my interactions when in public places: That people strike up random conversations with me, ask for directions, of if I could take a couple’s picture at a touristy hot spot, etc. These types of interactions are becoming less awkward to me in the last few years, and I initially attributed my approachability to giving off a “psychiatrist” vibe, as if people can sense that I’m trained to listen to people’s issues. Or, perhaps, as one friend pointed out, I appear to be the antithesis of “bitchy resting face” syndrome.

Flashback to around twenty years ago when I was a loner preteen in the girls’ locker room, where my locker was located in the same aisle as the most popular girls at my school. As I stared at the floor too shy to make eye contact, I recall trying to muster the courage to say something to them — anything — in hope of some kind of acknowledgement, a wave, even a “Hi” — anything to feel slightly less invisible than I already was. When I looked up directly towards them, words never left my mouth. All I had the courage to do was smile. A forced, awkward, and uncomfortable smile that caused my cheeks to fatigue.

And all that effort and energy exerted for the end result of coming off as creepy: “That girl is smiling too much,” was all they said. From then on and for quite some time, I became known as “that weird smiley girl.” As if smiling was a negative thing. And, as one could imagine, I didn’t smile for months thereafter. Little did they know how much of a hit to my self-esteem that one incident would have. Putting yourself out there only to get rejected sucks and may hinder further attempts to connect with others in the future.

One may perceive me as a highly sensitive, socially anxious person, and I don’t deny possessing those traits. However, rather than being identified with a label or descriptor (i.e., “that weird, smiley girl,” or “Vania is anxious and highly sensitive,”) I prefer that people acknowledge the different facets of my personality that make up who I am as an individual (i.e., “Vania has social anxiety and can be sensitive”). The general tone changes depending on the wording and language used. In the former statement, being anxious and highly sensitive are inferred to be words that define me, whereas the latter refers to anxious and highly sensitive as traits.

For many years, I viewed myself as abnormal. That is, until the last few years where I grew to appreciate the qualities that make me who I am as a unique individual, which I attribute to surrounding myself with an amazing support system, including my therapist, who helped me realize it. As a result, I no longer stare downward nor feel afraid to smile and chat with others.

An issue that I have with how psychiatry is perceived is the tendency to create labels. Many people have enough anxiety about seeking psychiatric help in the first place, and the fear of being labeled and stigmatized might sit at the top of one’s list of concerns. I’ve encountered several patients who told me they were diagnosed with a specific mental illness after one brief, initial 30-minute interview. “The doctor told me I’m bipolar without barely getting to know me” is a statement of different variations that I’ve heard several times in my practice. I try to maintain an open mind about my colleagues, especially those who are only allotted 15 to 30 minutes to meet with a new patient (which is ridiculous in medicine, especially in psychiatry) because the ability to see a high volume of patients within a short time frame and fully get to know each patient seems unrealistic and virtually impossible to maintain.

However, the last thing any person, including any medical provider, should do is make you feel like another label and essentially invisible or judged. Often when people muster up the courage to reach out and seek help are in times of desperation and in highly vulnerable states. The most therapeutic thing any person (or provider) can do is look you in the eye (even if you might be too afraid to look directly at them) and acknowledge you for who you are.

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Resist the tendency to label your patients 8 comments

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Vic Nicholls

Oh that this would be true. I’ve seen way too many, and its been blogged about a number of times by countless people, of getting the “mental” labels because the doctor didn’t test enough, didn’t like someone, etc. If there was true consequences of doing this, it would be a lot lower all the problems that happen to people because of it.

Also the blacklash or blacklisting and gaslighting that goes on, that would need to stop too.

If a person has the motivation to do so, it seems the more common consequences these days would be a patient writing a bad review about the doc. But yes, there could be a lot less problems if clinicians overall could be more thorough and thoughtful in their diagnoses.

good point but unfortunately the shift of treatment, esp that covered by insurance, has been to mostly meds only. I live in the LA area where the number of psychiatrists who also provide therapy is probably a lot higher compared to other parts of the country, but you’d have to be willing to pay an extensive amount of cash to see them.

bostonmeg

Psychpharmacologists are not new to the field but have definitely become much more prevalent.

I live Boston where it is next to impossible to find a psychiatrist who does therapy, no matter the amount of money you are willing to spend. I have been offered in-patient care countless times when my son didn’t need that level of care. He was bi-polar who was functioning. I am a psychologist who watched this make him feel like I wasn’t being honest about his condition.

It is the patients who are suffering without assistance and I don’t see a change coming.

I understand the compensation issue, lack of providers and even the burn out that can occur but no clinician – psychiatric or otherwise should make you feel “invisible”.

i completely agree that clinicians shouldn’t make anyone feel invisible — the reason i wrote this post because my patients would tell me their disheartening experiences. there’s definitely something wrong w/ our system if it’s much easier to place people on the inpatient unit than it is to refer to a good psychiatrist w/ time and availability, in which there’s a shortage of. i hope your son was able to get the care he needed. i wish there was a more immediate solution…until then, the least i’m at least trying to do is educate and advocate for my patients.

bostonmeg

Sadly no. He took his life.

I appreciate the job your doing. I just wish there were more out there doing it too.

Thanks for your comment and sharing your experience. that’s unfortunate re: your treatment in the ER. I suppose on the positive side, it’s nice to hear you have a caring grandson who accompanies and advocates for you during your appointments.